Iowa Workforce Development - Unemployment Insurance This form is for Employers to report Unemployed Claimants in Iowa who have refused legitimate job offers. All fields below are required for a successful submission. Language Undefined Name of Business: * Employer Account Number * Business E-mail: * Worksite Street Address: * Worksite City, State, Postal Code: * Business Area Code+Telephone: * Your Name and Title: * Name Of Person Who Made The Job Offer: * First and Last Name Of Claimant : * Last 4 of Social Security Number * xxx-xx- Month and Day of Birth * Year18831884188518861887188818891890189118921893189418951896189718981899190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day What did the claimant refuse? * Interview Job Offer Date of Job Refusal: * Starting Wage or Salary Offered: * How Was The Job Offer Made? * Please SelectIn PersonIn WritingBy PhoneBy Email or Other Electronic MeansOther Reason Given For Job Refusal: * Description Of Job Refused: * Name of person who offered the job interview? * Date the interview was offered? * Year20212022202320242025 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Starting wage of the position? * $.00 Wage period? * - Select -HourlyBi-WeeklyMonthlyAnnually How Was The Job Interview Offered? * Please SelectIn PersonIn WritingBy PhoneBy Email or Other Electronic MeansOther Reason for interview refusal? * Job Description * Additional Information * Leave this field blank Send Job Offer Decline Form Business
